European-wide implementation of clinical audits starts to gather momentum

March 08, 2019

Two surveys about the implementation of clinical audits across Europe will be the highlight
of today’s presentation by Dr. Adrian Brady, chairman of the ESR Quality, Safety and
Standards Committee. The results of the new research, which closed in December 2018, will underline that many countries have yet to introduce important European legislation.

European wide implementation of clinical audits

In the CT department of a Belgian hospital, radiographers, nurses, and technicians undergo audit training. Shown on the left are Evgenia Boldyreva, radiology technologist and head of training at Qaelum, Dr. Jan Schillebeeckx, and Dr. Tom Van Herpe.

In the CT department of a Belgian hospital, radiographers, nurses, and
technicians undergo audit training. Shown on the left are Evgenia Boldyreva,
radiology technologist and head of training at Qaelum, Dr. Jan Schillebeeckx,
and Dr. Tom Van Herpe.

“In a lot of countries, the idea of audit being part of our lives as radiologists is alien,” said Brady, a consultant radiologist at Mercy University Hospital, Cork, Ireland. “But, as well as needing to do it legislatively, it’s a good idea for your department to evaluate whether it’s meeting a reasonable standard.”

Article 58a of the European Council Basic Safety & Standards (BSS) Directive (2013/59/Euratom), which lays down basic safety standards for protection against the dangers arising from exposure to ionising radiation, requires that radiology departments perform clinical audits. The emphasis is on each national government to put the directive into practice, and clinical audits became compulsory on February 6, 2018.


According to Brady, clinical audit isn’t a new thing in Europe, but the implementation has traditionally varied between countries. “The U.K. and Ireland are a poster child for audit,” he said. “It’s a standard part of working life.”


In his talk, he will present results from a survey of EuroSafe Imaging Star departments to show how many of them have implemented the new requirements. A further survey of national societies aims to discover how many European Union member states have implemented nationwide structures to support clinical audits.


Brady noted that 36 out of 47 national societies and 68 out of 103 EuroSafe Imaging Star departments had given feedback in response to the surveys. “This is a really excellent response rate,” he said.
He will also explain how radiology departments can undertake clinical audit. There’s no specificity in the directive about what departments need to be auditing, and it’s up to the individual department, he added. One department might run an audit on waiting times, while
another could look at radiation protection issues.


To assist radiology departments, the ESR has released a Clinical Audit Tool booklet, Esperanto, containing 17 templates and other details to guide radiologists through audit in various situations. The first edition was originally published in 2017, but a second edition
containing 13 additional templates has been developed.


The 17 original templates, along with the six new ones, cover activities that must be measured under the directive. Most of this information relates to radiation exposure.
Another seven templates cover audit topics relating to service provision and clinical practice. These are not required to comply with legislation.


In today’s session, Dr. Jan Schillebeeckx, a consultant and former chief medical officer at Qaelum, a spinoff from the Leuven Catholic University in Belgium, will discuss the company’s software tools for clinical audits. He explains that the idea for his talk came from his own
experience of auditing 44 hospitals throughout Europe and the Middle East.


“We came to one common finding: there’s a lot of information available in hospitals and radiology departments, but the people on the ground don’t know where it is,” he said.


Thanks to a government grant, Qaelum began in 2013 to develop software to help with clinical auditing processes. The company began by collecting a large database of
multiple published documents, including good practice guidance, and then categorised and labelled the information.


Qaelum also created a large set of questions that could be used to run an audit. This was initially based on the Quality Assurance Audit for Diagnostic Radiology Improvement and Learning (QUAADRIL), the International Atomic Energy Authority’s official auditing scheme.
“We’ve run an algorithm to define the key content identifiers for each audit question, and then matched those questions with the information most likely to address them,” explained Dr. Tom Van Herpe, senior researcher at Qaelum.


According to Nelly Ilcheva, head of quality assurance and regulatory assurance at Qaelum, the software has other benefits in addition to audit. The system can work on a range of audit frameworks and easily convert between them. By monitoring compliance, the system can
help to detect, classify and – in the future – prevent major and minor errors, Schillebeeckx continued.


“Whatever audit scheme we take, we see similar errors recurring in radiology, some where there could be no harm to the patient, but we’ve also seen 10–15 major recurring
errors in every radiology department we’ve audited in the past, and this worried us,” he said.


The company is working with pilot hospitals to clinically validate the software, Ilcheva explained. The team has already validated the data management part of the software,
and will begin testing the compliance and audit functions in due course.